SCIENCE science.org 17 DECEMBER 2021 • VOL 374 ISSUE 6574 1441and that more countries should contrib-
ute high-quality demand data for the sake
of forecasting.
Enabling demand exibility
Vaccine procurement specifications typi-
cally limit the range of products that can
be purchased. They may require specific
product presentations (such as multidose
vials or prefilled syringes), suppliers of par-
ticular nationalities, or products and label-
ing that have been approved by the local
regulatory authorities. Where global policy
and regulatory recommendations support
the use of similar vaccines made by dif-
ferent manufacturers, greater flexibility
in product choice and procurement could
enhance access (9, 10). Such flexibility may
require acceptance of a product address-
ing fewer strains, or use of reliance mecha-
nisms, including WHO prequalification
(which enables procurement by United Na-
tions agencies) , that can expedite market-
ing authorization ( 11 ). Further regulatory
convergence on simplified, harmonized la-
bels acceptable across many jurisdictions
would increase flexibility in procurement.
LONG TERM PROSPECTS
Healthy markets for vaccines provide reli-
able, timely supplies of high-quality vac-
cines at sustainable prices and enable
innovation to meet evolving needs ( 12 ).
Although COVID-19 has posed new risks in
the short term, it has also driven several
changes that may create opportunities for
long-term improvements in market health.
First, once demand for COVID-19 vac-
cines is met, manufacturers and CMOs
will be left with a legacy of much higher
capacity. Although some downsizing is an-
ticipated, there will also be opportunities
to repurpose this capacity to address exist-
ing shortages; support the development
and manufacture of new vaccines or other
biomedical products; or maintain existing
manufacturing capacity in a state of readi-
ness to respond to future emergencies.
Leveraging this capacity will require a will-
ingness to invest in being better prepared
for the next pandemic.
Second, challenges in global access to
COVID-19 vaccines have led to calls for the
global diversification of vaccine manufac-
turing. Increasing manufacturing capacity
in underserved regions w ould accelerate
regional access to vaccines and improve
preparedness and rapid response for fu-
ture emergencies.
Third, newer vaccine platforms such as
nucleic acid and viral-vectored vaccines
are showing their flexibility and utility in
the response to the COVID-19 pandemic.
These new platforms can drastically accel-
erate adaptation to new pandemic and sea-
sonal influenza strains; could be applied to
additional pathogens, accelerating access
to new vaccines; and could potentially be
used in curative applications—for example,
as cancer vaccines (13, 14).
Finally, the mitigation strategies dis-
cussed above will yield a more efficient and
resilient vaccine manufacturing ecosys-
tem. In future pandemics, this ecosystem
will better enable rapid, equitable access
to pandemic vaccines and ensure reliable
supplies of other essential vaccines.STRONG, PRE EMPTIVE, AND COORDINATED
The global response to the COVID-19 pan-
demic has demonstrated the power of
vaccines to fight disease and the power
of global collaboration to achieve unprec-
edented speed and scale in the discovery,
manufacture, and delivery of new vaccines.
It has also shown the importance of equi-
table access to vaccines and of resilient
health systems that can deliver routine
care, including vaccination, while coping
with health emergencies.At the same time, COVID-19 is creating
challenges for other vaccines. Disruptions
in the supply of essential infant and ado-
lescent vaccines will disproportionately af-
fect poorer countries, which are at greater
risk of disease.
Owing to complex manufacturing pro-
cesses and long production times, manufac-
turing constraints are typically slow to show
their full impact, with a delay sometimes up
to 12 to 18 months. Similarly, actions taken
may not result in increased supplies for
over a year. It is therefore critical to iden-
tify and mitigate risks to vaccine supplies as
early as possible to minimize their impact.
Mitigating those risks requires a strong,
pre-emptive, and coordinated effort. The
measures proposed in this paper build
on innovative collaborations underway to
accelerate access to COVID-19 vaccines.
Expanding their scope will help ensure
reliable supplies of all essential vaccines.
Moreover, applying these mechanisms
more broadly will contribute to healthier
vaccine markets that are better preparedto respond to future emergencies.
The actions described here are needed
to enable recovery, extend the benefits
of immunization to underserved popula-
tions, and speed the introduction of new
vaccines, contributing to a healthier, safer,
and more prosperous future ( 15 ). jREFERENCES AND NOTES- World Health Organization, UNICEF, “Progress
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ACKNOWLEDGMENTS
We thank all those who contributed data and perspectives to
this analysis, the Market Information for Access to Vaccines
Advisory Group, the participants of the WHO workshops on
impact of COVID-19 on supply of other vaccines, and A. Hwang
for editorial support. The views expressed in this article are
the personal views of the authors and may not be understood
or quoted as being made on behalf of or reflecting the position
of the agencies or organizations with which the authors are
employed or affiliated. The authors receive funding from the
Bill & Melinda Gates Foundation (grant 70988 to WHO), core
funding from the WHO program budget, and funding from
WHO (contract 202651859 to S.M.). The authors declare no
interests beyond those shown on the title page.SUPPLEMENTARY MATERIALS
science.org/doi/10.1126/science.abl701910.1126/science.abl7019“Increasing manufacturing
capacity in underserved
regions would accelerate
regional access to vaccines
and improve preparedness
and rapid response...”